DOI: 10.1097/01.ccm.0000457886.43974.af
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Issn Print: 0090-3493
Publication Date: 2014/12/01
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Excerpt
Methods: We conducted a secondary analysis of data prospectively collected from a random sample of patients (n=10,078) admitted to CPCCRN-affiliated PICUs between December 4, 2011 and April 7, 2013.1 Patients were eligible for inclusion during the first PICU admission of their hospital stay; moribund patients were excluded. Data are expressed as absolute counts and percentages (overall and range across sites), and means and standard deviations. We evaluated the association between key characteristics and site using Pearson chi-square or Fisher’s exact test.
Results: 275 (2.7%, range across sites 1.3%-5.0%) patients (age 4.5±5.6 years) died during their hospital stay; of these, 252 (92%, 76%-100%) died in a PICU. Discussions with family regarding limitation/withdrawal of support (LWS) were documented during the initial PICU stay for 173 (63%, 47%-76%, p=0.27) patients who died. Of these, palliative care was consulted for 67 (39%, 12%-46%); pain service for 11 (6%, 10 of which were at a single site); and ethics committee for 6 (3%, from 3 sites). Mode of death did not differ significantly by site (p=0.57) and was LWS for 187 (68%, 56%-76%) patients, failed CPR for 53 (19%, 12%-28%), and brain death for 35 (13%, 8%-20%). Organ donation was offered for 101 (37%, 17%-88%, p<0.001) patients; of these, 20 (20%, 0%-64%) donated. 62 (23%, 10%-53%, p<0.001) deaths were deemed medical examiner (ME) cases. Of non-ME cases (n=213), autopsy was requested for 79 (37%, 17%-75%, p<0.001). Of autopsies requested, 53 (67%, 50%-100%) were performed.
Conclusions: Across CPCCRN-affiliated PICUs, most deaths occur after life support has been limited or withdrawn. However, wide practice variation exists in requests for organ donation and autopsy. 1Pollack MM, et al.
